Suppositories are solid forms that can be administered rectally. How do they act? In what cases should they be used? Constipation ? Hemorrhoids? How to administer them? What are the side effects and contraindications?
Definition: what is a suppository?
It’s a solid pharmaceutical preparation of conical or ovoid shape which is administered rectally. A suppository has a variable composition depending on the desired action: local (acts on the rectum and anus) or systemic (passes into the blood).
Locally, a suppository can:
- lubricate, protect the rectal mucosa or even induce an anesthetic effect (for the hemorrhoidal crisis)
- increase defecation reflex, cause a secretion of water in the intestine (for constipation). Topical laxatives usually work in 10 to 30 minutes
Systemically (generally), a suppository has various properties depending on its active ingredient: antitussive, antipyretic (against fever), analgesic, anti-inflammatory, anti-vomiting, antispasmodic. Absorption of the active ingredient is mediated through the rectal veins to be transported to the liver. The mechanism of action of the drug is identical to that of the molecule administered orally, except for the stages of metabolism by the liver and absorption in the upper part of the intestine.
When to use a glycerin suppository?
A glycerin suppository is a laxative used to symptomatically treat low constipation which is characterized by a difficulty in evacuating the stools present in the rectum (terminal part of the intestine). This medicine can also be used for cleaning the rectum for a medical examination (radiology, endoscopy of the rectum and sigmoid).
When to use Titanorein suppository?
Titanoréïne® suppository is used to treat pain and itching in a context of hemorrhoidal crisis. This medication protects and lubricates the mucous membranes of the anus and rectum.
When to use an effervescent suppository?
The effervescent suppositories currently marketed are the specialties Eductyl® children and Eductyl® adults. This drug is used to treat low constipation and to clean the rectum in preparation for medical examinations (radiology, endoscopy of the rectum and sigmoid). Its administration results in release of carbon dioxide which increases the pressure on the intestinal mucous membranes and thus causes a rapid evacuation of the stool, less than ten minutes.
Prolonged use of a suppository is strongly discouraged.
Which suppository when is constipated?
This type of suppository has a laxative action that induces contraction of the rectum to facilitate the evacuation of stools. Several suppositories are available to facilitate defecation: Dulcolax®, Eductyl® children, Eductyl® adults, Rectopanbiline® and glycerin suppositories exist under several brand names depending on the laboratory.
After carefully removing it from the package, the suppository can be moistened in cold water to harden it and thus facilitate its introduction into the anus. Laboratories recommend to administer a suppository by the flat side. Once introduced, the muscles of the rectum contract at the pointy end, which promotes propulsion to the intestine. Inserting a suppository from the pointed side is associated with a risk of expulsion. Administration in an infant requires positioning him on his back by folding both legs over the chest or on the side by folding only one leg. You must then spread her buttocks apart, introduce the suppository deep into her anus by pushing with your index finger and hold her buttocks tight for a few minutes.
What are the side effects of suppositories?
All suppositories can cause irritation or even burning in the anus and rectumand more exceptionally inflammations of the rectal mucosa and allergic reactions. The frequency of occurrence and the intensity of these effects are dependent on the duration of treatment and the administration schedule. More specifically, the side effects of suppositories result from the active ingredient. For example, a suppository based on paracetamol presents the same risks as other pharmaceutical forms based on paracetamol (tablet, capsule, drinkable powder, etc.). In addition, a suppository containing essential oils can be responsible for agitation and confusion in the elderly, and convulsions in infants due to the presence of terpenes (natural hydrocarbons).
What are the contraindications to the suppository?
All suppositories are contraindicated in case of allergy to any of the components of the drug and in patients who have had recent lesions in the anus or rectum. Some suppositories such as Titanoréine® do not present any other specific contraindications. Also, laxative suppositories should not be used in case of inflammatory bowel disease, Crohn’s disease, hemorrhoidal crisis, intestinal obstruction or a state of severe dehydration. The other contraindications are specific to the active ingredient contained in the suppository. For example, a paracetamol-based suppository is prohibited in cases of severe liver disease.
What precautions should be taken when using a suppository?
Whatever the therapeutic action sought, prolonged use of a suppository is strongly discouraged. Note that a laxative suppository should be administered punctually. The management of constipation must be associated with fiber-rich diet, adequate fluid intake and regular physical activity. Similarly, suppository treatment indicated in hemorrhoidal crisis should be discontinued in case of persistence or worsening of symptoms. Prior to administration, make sure the size of the suppository is appropriate for the age of the person. Indeed, some specialties are available in several presentations intended for infants, children or adults. A drug presented in the form of a suppository must be taken as seriously as a drug in a tablet since the active substance remains the same, only the route of administration changes. Compliance with the recommended doses is therefore essential to limit side effects. Before using a suppository, it must take into account any drugs that have been administered via another route (oral, injectable, etc.) in order to limit the risks of overdose and drug interactions. More specifically, before using Titanoréïne® in a suppository, a patient having an emission of blood through the anus or blood in the stools must consult a doctor in order to exclude any serious pathology.
Sources:
– Public drug database, ANSM
– Pediadol
– Cooper Laboratory